Provider Demographics
NPI:1508416934
Name:RASKIN, LISA GAIL (DC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:GAIL
Last Name:RASKIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:GAIL
Other - Last Name:RASKIN ECKSTEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:2299 PEARL ST STE 204
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-4670
Mailing Address - Country:US
Mailing Address - Phone:512-698-3902
Mailing Address - Fax:512-853-8654
Practice Address - Street 1:2299 PEARL ST STE 204
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-4670
Practice Address - Country:US
Practice Address - Phone:512-698-3902
Practice Address - Fax:512-853-8654
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR0007939111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty